bleeding and shock and shock - scfr
TRANSCRIPT
CHAPTER 26
Bleeding and Shock
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
and Shock
Review of Circulatory
System
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
System
Review of Circulatory System
Heart
Blood
Blood Vessels
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Arteries
Capillaries
Veins
Circulatory System
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Perfusion
Key Term
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Circulation of blood through an organ
Hypoperfusion
Key Term
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Inadequate circulation of blood
through an organ
ExternalBleeding
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Bleeding
Take BSI precautions when controlling Take BSI precautions when controlling bleeding.bleeding.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
3 Types of 3 Types of External External BleedingBleeding
Arterial
Capillary
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Capillary
Venous
Severity of Blood LossDetermined by:
General impression of blood loss
Signs or symptoms of
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Signs or symptoms of
hypoperfusion
Sudden loss of...
One liter of blood in an adult
Half a liter of blood in a child
100-200cc of blood in an infant
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
...is serious!
Uncontrolled bleeding or
significant blood loss leads to
shock (hypoperfusion) and
possibly death!
Blood Loss
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not wait for signs and
symptoms to appear before
beginning treatment!
Direct PressureDirect Pressure
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
ElevationElevation
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Pressure Pressure BandageBandage
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Point Pressure Point –– BrachialBrachial
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Pressure Point Pressure Point –– FemoralFemoral
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Supplemental Methods ofBleeding
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
BleedingControl
SplintingSplinting
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Air SplintingAir Splinting
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
A tourniquet is a last resort.A tourniquet is a last resort.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Bleeding fromthe Nose, Ears,
and Mouth
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
and Mouth
Managing Managing a Simple a Simple NosebleedNosebleed
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Skull Fracture
May cause loss of blood or clear
fluid (cerebrospinal fluid) from the
nose and ears.
Do not stop the flow of fluid.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Do not stop the flow of fluid.
Internal BleedingInternal Bleeding
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Severity of Internal Bleeding Should Be Based on:
Mechanism of injury
Clinical signs and symptoms
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Consider Consider mechanismmechanismof injury.of injury.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Mechanism of Injury May Include:
Falls
Auto, motorcycle, or pedestrian
accidents
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
accidents
Penetrating trauma
Blast Injuries
Signs & Symptomsof Internal Bleeding
Significant MOI
Pain, tenderness, deformity, swelling,
discoloration
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
discoloration
Bleeding from the mouth, rectum, or
vagina
Tender, rigid, or distended abdomen
Signs & Symptoms of InternalBleeding
Vomiting blood
Bright red
Coffee-ground color and consistency
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Coffee-ground color and consistency
Blood in stool
Bright red
Dark, tarry
Signs & Symptoms of Internal Bleeding
Capillary refill time > 2 seconds
Infants and children only: Nausea
and vomiting
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
and vomiting
Decreasing blood pressure (late
sign)
Dilated pupils (late sign)
Emergency Care of Internal Bleeding
BSI
Maintain airway; administer
oxygen.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
oxygen.
Control any external bleeding.
Emergency Care of Internal Bleeding
Splint if injured area is on an
extremity.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Transport immediately.
Signs of shock
(hypoperfusion) appear
LATE!
Waiting for signs of shock to
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Waiting for signs of shock to
appear before recognizing and
treating may result in the DEATH of
your patient.
ShockShock
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Inadequate perfusion of cells with
oxygen and nutrients
AND
Inadequate removal of metabolic
Shock (Hypoperfusion)
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Inadequate removal of metabolic
waste products
Inability of heart to pump
Decreased supply of blood
Lack of integrity in blood vessels
Causes of Shock
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© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Failure of vessels to dilate &
constrict
To compensate for shock, the body shunts blood away from areas of lesser need to areas of
Early Shock
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
areas of lesser need to areas of greater need.
Reduced perfusion results in
malfunction of cells and organs.
When this is not recognized and
Late Shock
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
When this is not recognized and
treated, death may result.
Signs & Symptoms of Shock
Restlessness, changes in
mental status
Pale, cool, and clammy skin
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Increased pulse rate
Increased respiratory rate
Continued…
Signs & Symptoms of Shock
Decreasing blood pressure is a
LATE sign.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Continued…
Signs & Symptoms of Shock
Pulse oximetry may be unreliable
Nausea and vomiting
Dilated pupils
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Dilated pupils
Thirst
Cyanosis
Continued…
Signs & Symptoms of Shock(Infants & Children)
Capillary refill time > 2 seconds
May maintain blood pressure until
blood volume is half gone
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
blood volume is half gone
By the time an infant’s or child’s
blood pressure drops, they are
NEAR DEATH!
Emergency Care of Shock
Rapid transport is goal.
Golden Hour
Platinum Ten Minutes
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Platinum Ten Minutes
Take BSI precautions.Take BSI precautions.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Maintain airway; administer oxygen.Maintain airway; administer oxygen.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Control external bleeding.Control external bleeding.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Emergency Care of Shock
Splint suspected bone or joint
injuries.
Do not delay transportation.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Backboard can be used to splint
the entire body.
Apply PASG if indicated.Apply PASG if indicated.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Elevate lower extremities 8Elevate lower extremities 8--12 inches.12 inches.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Prevent loss of body heat.Prevent loss of body heat.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Transport immediately.Transport immediately.
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
1. Describe the following types of
bleeding:
Arterial
Capillary
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Capillary
Venous
2. Describe the emergency care for
external bleeding.
3. List the signs and symptoms of
internal bleeding.
4. Describe the emergency care for
internal bleeding.
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
internal bleeding.
5. Define shock (hypoperfusion).
6. List the signs and symptoms
of shock in the order in which
they are likely to appear.
Review Questions
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
they are likely to appear.
7. Describe the emergency care
for shock (hypoperfusion).
What is the priority for this patient?
Does an initial assessment still need
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
Does an initial assessment still need
to be done?
What assessment information do you
want to receive from Squad 31?
Is the mechanism of injury important
information for this patient?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
information for this patient?
What is the treatment priority for this
patient?
How often should you get a new set
of vital signs?
STREET SCENESSTREET SCENES
Limmer et al., Emergency Care Update, 10th Edition
© 2007 by Pearson Education, Inc. Upper Saddle River, NJ
of vital signs?